eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Bronchiectasis: Follow-up

Author: Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Coauthor(s): Pauline Fani, MD, Fellow, Department of Pediatrics, Division of Pulmonary Medicine, Columbia University Children's Hospital; Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Contributor Information and Disclosures

Updated: Sep 8, 2009

Follow-up

Further Inpatient Care

  • Children with bronchiectasis may require inpatient intravenous antibiotics when they experience exacerbations of endobronchial disease. Exacerbation may be characterized by increased cough or sputum production or changes in pulmonary function. 
  • The initial course of treatment may be oral antibiotics and aggressive airway clearance. If the patient is unresponsive to oral antibiotics, intravenous antibiotic therapy and hospitalization may be necessary. Home intravenous antibiotic therapy may be an option in some situations.
  • Systemic corticosteroids may be used to treat any reactive airway component, when appropriate.

Further Outpatient Care

  • Children should be seen frequently, generally every 3-4 months, when stable and should be seen more frequently if they are not stable. 
  • Spirometry is recommended at every visit in children older than 5 years.
  • Chest radiograph need not be empirically repeated. If the clinical course changes, a radiograph should be part of the assessment.

Transfer

  • Consider transferring the care of the child with bronchiectasis to a pediatric pulmonary center if clinical deterioration, frequent or increased symptoms, or hemoptysis occurs.

Deterrence/Prevention

  • Childhood immunization for measles or pertussis has reduced bronchiectasis in the developed world. Screening for tuberculosis and other successful public health measures minimizes the risk of this disease in children.
  • Aggressive appropriate therapy of lower respiratory tract infections may prevent bronchiectasis. However, because some viruses predispose to bronchiectasis, this therapy is not always successful.
  • Therapy of the child with chronic or recurrent respiratory problems due to recurrent aspiration and/or gastroesophageal reflux disease is important to reduce the likelihood of developing bronchiectasis.

Complications

  • Progressive bronchiectasis from underlying disease (eg, cystic fibrosis [CF]) or ongoing pulmonary insult (aspiration syndromes) causes a progressive obstructive defect and, ultimately, respiratory compromise. This may manifest as dyspnea at rest or with exercise or sleep-disordered breathing.
  • Progressive diffuse pulmonary damage may lead to chronic hypoxemia, pulmonary hypertension, cor pulmonale, hypercarbia, respiratory failure, and death.
  • Progressive focal disease may lead to progressive infection with fever and abnormal growth. The area may contribute enough ventilation/perfusion mismatch to cause hypoxemia with exercise. Although not yet proven, infected secretions from the abnormal portion of the lung could spill over to other portions of the lung, causing more widespread infection.

Prognosis

  • Overall, the prognosis is good for a child with bronchiectasis. The key to a successful outcome is determining whether the cause of the damage is ongoing (eg, chronic aspiration) and then treating the problem.
  • Growth of new pulmonary tissue in children proceeds rapidly until about age 6 years and then tapers off through childhood. Injury at an early age may be compensated for by growth of normal healthy lungs in the absence of ongoing damage.
  • Treating any underlying disorder can help prevent the progression of bronchiectasis. Chest drainage and antibiotics can help treat the bronchiectasis itself.
  • In the absence of an underlying condition, children with isolated bronchiectasis often have a good prognosis.

Patient Education

  • Chest physiotherapy and postural drainage are important elements in the treatment of bronchiectasis and should be taught to the child's parents early in the course of disease. This is especially true when the child produces significant amounts of sputum. Physiotherapy techniques should be frequently reviewed and retaught.
  • For excellent patient education resources, visit eMedicine's Bacterial and Viral Infections Center. Also, see eMedicine's patient education article Tuberculosis.

Miscellaneous

Medicolegal Pitfalls

  • Bronchiectasis is a relatively uncommon condition often unsuspected in a child with previously diagnosed obstructive pulmonary disease, such as asthma. The clinician must remember that asthma does not cause digital clubbing. A child with asthma and clubbing should be evaluated further. The child with asthma who does not respond as expected to therapy should be evaluated further.
  • In patients with suspected bronchiectasis without characteristic chest radiograph findings, an high-resolution CT (HRCT) scan is the diagnostic procedure of choice.
  • Efforts should be made to determine any etiology of bronchiectasis.
  • Children should be monitored throughout their lives by a clinician comfortable with the management of chronic lung disease.

Special Concerns

  • Prolonged therapy with systemic or high-dose inhaled corticosteroids may affect growth and increase the risk of other complications of steroids.
  • In patients with non–cystic fibrosis (CF) bronchiectasis, prolonged systemic antibiotics may produce a small benefit and reduce sputum volume and purulence but may also be associated with unpleasant side effects.
 


More on Bronchiectasis

Overview: Bronchiectasis
Differential Diagnoses & Workup: Bronchiectasis
Treatment & Medication: Bronchiectasis
Follow-up: Bronchiectasis
Multimedia: Bronchiectasis
References
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References

  1. Clark NS. Bronchiectasis in childhood. Br Med J. Jan 12 1963;5323:80-8. [Medline].

  2. Weycker D, Edelsberg J, Oster G, Tino G. Prevalence and economic burden of bronchiectasis. Clin Pulm Med. 2006;12:205.

  3. Field CE. Bronchiectasis. Third report on a follow-up study of medical and surgical cases from childhood. Arch Dis Child. Oct 1969;44(237):551-61. [Medline].

  4. Twiss J, Metcalfe R, Edwards E, Byrnes C. New Zealand national incidence of bronchiectasis "too high" for a developed country. Arch Dis Child. Jul 2005;90(7):737-40. [Medline]. [Full Text].

  5. Callahan CW. Bronchiectasis: abated or aborted?. Respiration. May-Jun 2005;72(3):225-6. [Medline].

  6. Redding G, Singleton R, Lewis T, Martinez P, Butler J, Stamey D. Early radiographic and clinical features associated with bronchiectasis in children. Pediatr Pulmonol. Apr 2004;37(4):297-304. [Medline].

  7. Field CE. Bronchiectasis in childhood. I. Clinical survey of 160 cases. Arch Dis Child. 1949;4:21-46.

  8. Karadag B, Karakoc F, Ersu R, et al. Non-cystic-fibrosis bronchiectasis in children: a persisting problem in developing countries. Respiration. May-Jun 2005;72(3):233-8. [Medline].

  9. Twiss J, Stewart AW, Byrnes CA. Longitudinal pulmonary function of childhood bronchiectasis and comparison with cystic fibrosis. Thorax. May 2006;61(5):414-8. [Medline].

  10. Akalin F, Koroglu TF, Bakac S, Dagli E. Effects of childhood bronchiectasis on cardiac functions. Pediatr Int. Apr 2003;45(2):169-74. [Medline].

  11. Morrissey BM, Harper RW. Bronchiectasis: sex and gender considerations. Clin Chest Med. Jun 2004;25(2):361-72. [Medline].

  12. Tsao PC, Lin CY. Clinical spectrum of bronchiectasis in children. Acta Paediatr Taiwan. Sep-Oct 2002;43(5):271-5.

  13. Lai SH, Wong KS, Liao SL. Clinical analysis of bronchiectasis in Taiwanese children. Chang Gung Med J. Feb 2004;27(2):122-8. [Medline].

  14. Edwards EA, Metcalfe R, Milne DG, Thompson J, Byrnes CA. Retrospective review of children presenting with non cystic fibrosis bronchiectasis: HRCT features and clinical relationships. Pediatr Pulmonol. Aug 2003;36(2):87-93. [Medline].

  15. Davies G, Wilson R. Prophylactic antibiotic treatment of bronchiectasis with azithromycin. Thorax. Jun 2004;59(6):540-1. [Medline].

  16. Anwar GA, Bourke SC, Afolabi G, et al. Effects of long-term low-dose azithromycin in patients with non-CF bronchiectasis. Respir Med. Oct 2008;102(10):1494-6. [Medline].

  17. [Guideline] Rosen MJ. Chronic cough due to tuberculosis and other infections: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):197S-201S. [Medline].

  18. Otgun I, Karnak I, Tanyel FC, et al. Surgical treatment of bronchiectasis in children. J Pediatr Surg. Oct 2004;39(10):1532-6. [Medline].

  19. Balkanli K, Genc O, Dakak M, et al. Surgical management of bronchiectasis: analysis and short-term results in 238 patients. Eur J Cardiothorac Surg. Nov 2003;24(5):699-702. [Medline].

  20. Barker AF. Bronchiectasis. N Engl J Med. May 2 2002;346(18):1383-93. [Medline].

  21. Barker AF, Bardana EJ Jr. Bronchiectasis: update of an orphan disease. Am Rev Respir Dis. Apr 1988;137(4):969-78. [Medline].

  22. Beirne PA, Banner NR, Khaghani A, Hodson ME, Yacoub MH. Lung transplantation for non-cystic fibrosis bronchiectasis: analysis of a 13-year experience. J Heart Lung Transplant. Oct 2005;24(10):1530-5. [Medline].

  23. Evans DJ, Bara AI, Greenstone M. Prolonged antibiotics for purulent bronchiectasis. Cochrane Database Syst Rev. 2003;CD001392. [Medline].

  24. Farrell PM, Li Z, Kosorok MR, et al. Longitudinal evaluation of bronchopulmonary disease in children with cystic fibrosis. Pediatr Pulmonol. Sep 2003;36(3):230-40. [Medline].

  25. Kellett F, Redfern J, Niven RM. Evaluation of nebulised hypertonic saline (7%) as an adjunct to physiotherapy in patients with stable bronchiectasis. Respir Med. Jan 2005;99(1):27-31. [Medline].

  26. Lewiston NJ. Bronchiectasis in childhood. Pediatr Clin North Am. Aug 1984;DA - 19840919(4):865-78. [Medline].

  27. Lewiston NJ. Bronchiectasis. In: Hilman BC, ed. Pediatric Respiratory Disease. Philadelphia, Pa: WB Saunders; 1993:222-29.

  28. Mysliwiec V, Pina JS. Bronchiectasis: the 'other' obstructive lung disease. Postgrad Med. Jul 1999;106(1):123-6, 128-31. [Medline].

  29. Orriols R, Roig J, Ferrer J, et al. Inhaled antibiotic therapy in non-cystic fibrosis patients with bronchiectasis and chronic bronchial infection by Pseudomonas aeruginosa. Respir Med. Jul 1999;93(7):476-80. [Medline].

  30. Reid LM. Reduction in bronchial subdivision in bronchiectasis. Thorax. Sep 1950;5(3):233-47. [Medline].

  31. Scheinberg P, Shore E. A pilot study of the safety and efficacy of tobramycin solution for inhalation in patients with severe bronchiectasis. Chest. Apr 2005;127(4):1420-6. [Medline].

  32. Sirmali M, Turut H, Kisacik E, et al. The relationship between time of admittance and complications in paediatric tracheobronchial foreign body aspiration. Acta Chir Belg. Nov-Dec 2005;105(6):631-4. [Medline].

  33. Smyrnios NA, Irwin RS, Curley FJ. Chronic cough with a history of excessive sputum production. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Chest. Oct 1995;108(4):991-7. [Medline]. [Full Text].

  34. Tsang KW, Tipoe GL. Bronchiectasis: not an orphan disease in the East. Int J Tuberc Lung Dis. Jun 2004;8(6):691-702. [Medline].

  35. Yuan N, Skaggs DL, Dorey F, Keens TG. Preoperative predictors of prolonged postoperative mechanical ventilation in children following scoliosis repair. Pediatr Pulmonol. Nov 2005;40(5):414-9. [Medline].

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Further Reading

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Keywords

bronchiectasis, bronchiectasia, destruction of airways, inflammation of the airway, bronchial dilatation, cystic fibrosis, CF, tuberculosis, pneumonia, cylindrical bronchiectasis, varicose bronchiectasis, saccular bronchiectasis, focal bronchiectasis, diffuse bronchiectasis, human immunodeficiency virus, HIV, primary ciliary dyskinesia, adenovirus, measles, Mycobacterium avium, or Aspergillus fumigatus, recurrent pneumonia, bronchitis, asthma, gastroesophageal reflux disease, allergic bronchopulmonary aspergillosis, pertussis, tracheoesophageal fistula, Marfan syndrome, Bruton agammaglobulinemia, Mounier-Kuhn syndrome, Williams-Campbell syndrome, connective tissue disorder, rheumatoid arthritis, systemic lupus erythematosus, treatment, diagnosis

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Contributor Information and Disclosures

Author

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

Coauthor(s)

Pauline Fani, MD, Fellow, Department of Pediatrics, Division of Pulmonary Medicine, Columbia University Children's Hospital
Pauline Fani, MD is a member of the following medical societies: American College of Chest Physicians
Disclosure: Nothing to disclose.

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Medical Editor

Thomas Scanlin, MD, Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School
Thomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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